NHIS resolves tariff dispute for healthcare providers, HMOs

The National Health Insurance Scheme (NHIS) has amicably resolved the dispute between Health Care Providers (HCPs) and Health Maintenance Organizations (HMOs) to avoid possible service disruption in the country.

It would be recalled that hospitals under the aegis of Health Care Providers Association of Nigeria (HCPAN) and other associate bodies had announced plans to drop Health Maintenance Organizations (HMOs) and imposed a new tariff structure for private health insurance from February 1, 2022, which development had created anxiety within the health insurance ecosystem.

The Executive Secretary of the National Health Insurance Scheme (NHIS), Prof Mohammed Sambo, said the parties reached an interim but mutual understanding aimed at ensuring that a potential crisis is averted and persons operating health insurance on a private basis are not stranded.

Private health insurance is a practice where HMOs buy health care for interested persons under pre-determined arrangements. Usually, it is outside NHIS system.

Sambo stated that NHIS was the only legally recognized body that has the authority to come up with services tariffs for health insurance in the country, noting that the primary objectives of social health insurance was to limit the rising cost of health care services and protect people from financial hardships of huge medical bills.

Sambo, however indicated reservations that the system had tolerated HMOs to run “Private Health Insurance” which brought distortion to social health insurance implementation, expressing the optimism that the expected passage of the NHIS bill making health insurance mandatory will permanently resolve all such distortions.

“Social health insurance is the only vehicle by which every Nigerian can access quality and affordable health care. Therefore any element that will threaten the smooth operations of the social health insurance scheme in Nigeria must be eliminated”*, Sambo said.

Sambo further noted that taking the issue to the public space in the manner which the stakeholders did leave much to be desired, adding that disagreements can be resolved when parties listen to each other’s positions and make effort to reach a compromise.

Speaking on behalf of Health Care Providers, Dr Jimmy Arigbabuwo stated that HMOs had foisted their own tariffs on providers without regard for inflationary realities, insisting that HMCAN had not acted in good faith even as they provide services to their clients.

For their part, the spokesman for HMCAN Dr Leke Oshuniyi said that members of the association were open to negotiations with the view to bringing the dispute to a close.

At the end of the meeting, representatives of the Health and Managed Care Association of Nigeria (HMCAN), Health Care Providers Association of Nigeria (HCPAN), Guild of Medical Directors, AGPMPN and other stakeholders agreed to propositions presented by the Executive Secretary of NHIS.

The parties agreed that: A reconciliation exercise will be conducted by NHIS to ascertain the level of Indebtedness by HMOs to providers. A media advertorial will precede this activity.

“A rapid assessment of HMOs’ private plans will be conducted to ascertain their level of conformity with the NHIS prescribed arrangements”.

“HCPAN will immediately withdraw its announced tariffs while other stakeholders who had their own tariffs will withdraw same”.

“HCPAN and HMCAN are given two weeks to negotiate and agree on a mutually accepted tariffs structure. A follow-up meeting has been scheduled for February 7, 2022, to evaluate progress made”.

“The National Health Insurance Scheme (NHIS) intervened in the crisis in its capacity as the regulator of health insurance practice in Nigeria”.

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